Obesity

Question 1

Definition

Answer 1

Characterised by an accumulation of excess body fat , typically resulting from a chronic imbalance between energy intake and expenditure

Question 2

Obesity classifications

Answer 2

Body mass index (BMI):
- Overweight : BMI 25.0 - 29.9 kg/m 2
- Obesity class I: 30.0 - 34.9 kg/m 2
- Obesity class II: 35.0 - 39.9 kg/m 2
- Obesity class III: ≥40.0 kg/m 2 , this is also known as severe or morbid obesity

Question 3

Cut offs for POC

Answer 3

South Asian, Chinese, Middle Eastern, Black African or African-Caribbean):
- Overweight: BMI 23 to 27.4 kg/m 2
- Obesity: ≥27.5 kg/m 2

Question 4

Epidemiology

Answer 4

• Genetic predisposition
• Unhealthy diet: excess processed, calorie-dense, nutrient-poor foods
• Sedentary lifestyle
• Hypothyroidism
• Cushing’s syndrome or corticosteroid use
• Lower socioeconomic status

Question 5

Pathophysiology

Answer 5

• Excess adiposity contributes to systemic inflammation and hormonal changes , promoting insulin resistance and various obesity-related comorbidities

Question 6

Signs

Answer 6

• Increased waist circumference
• Elevated blood pressure
• Acanthosis nigricans

Question 7

Symptoms

Answer 7

• Dyspnoea
• Joint paint
• Snoring or sleep apnoea

Question 8

Diagnosis

Answer 8

FIRST LINE: BMI calculation
Consider:
- Blood tests: FBC, LFT, Lipid profile, HbA1c, TFT
- ECG: for IHD, Arrhythmias

Question 9

Treatment

Answer 9

FIRST LINE: Lifestyle modifications
Second line:
- Orlistat: considered if BMI >30kg/m2 or >29kg/m2 + co-morbidities
- Bariatric surgery: BMI>40kg/m2 or >35kg/m2 with co-morbidities
- Semaglutide: once-weekly, long acting subcutaneous injection, increases insulin secretion and suppress appetite. 2 year support. For BMI > 35kg/m2 + min 1 weight-related co-morbidity

Question 10

Complications

Answer 10

CVD: HTN, IHD
Metabolic: T2DM
Resp: Obstructive sleep apnoea
Musculoskeletal: osteoarthritis, back
Psychological: depression, social isolation
Cancer: breast, colorectal and endometrial